Esophagogastrostomy approaches offer mixed benefits
Last Updated: 2011-07-25 16:41:28 -0400 (Reuters Health)
NEW YORK (Reuters Health) - For esophageal reconstruction, end-to-side (ETS) and end-to-end (ETE) anastomoses each have advantages and disadvantages, as Dutch researchers have found.
"An ETS cervical esophagogastric anastomosis in the neck is associated with a lower anastomotic stricture rate, compared to the ETE technique," they conclude. "However, the ETS technique is accompanied by an increased anastomotic leak rate and a longer in-hospital stay."
The research team enrolled 128 patients undergoing esophagectomy and gastric tube reconstruction and randomized them to either an ETE or ETS group. The primary endpoint was anastomotic stricture, "because it defeats one of the main aims of surgery, which is to restore normal swallowing function," said Dr. Jeroen de Jonge and colleagues at Erasmus Medical Centre, Rotterdam online June 30th in Annals of Surgery.
At one year, benign stenosis requiring dilatation had occurred significantly more often in the ETE group than the ETS group (40% vs. 18%).
But patients in the ETS group also showed a trend toward more surgical site infections and a higher reoperation rate, and they were significantly more likely to have postoperative pneumonia (44% vs. 17%) -- which in turn contributed to significantly longer hospital stays (22 vs. 15 days).
And the combined clinical and radiological anastomotic leak rate was lower in the ETE group (22% vs. 41%), which the investigators say was another factor tied to reoperation and hospitalization in the ETS group.
There was no significant difference between groups in 30-day mortality or in-hospital mortality, or in one-year survival (63% with ETE, 72% with ETS).
Ann Surg 2011.
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